July 24, 2019
Starting Sept. 1, 2019, there are important changes to the prior authorization requirements for your Blue Cross and Blue Shield of Texas (BCBSTX) patients who are UT SELECT members. These members can be identified by employer group 071778 on their BCBSTX identification cards.
Providers will need to obtain prior authorization for an expanded list of select specialized services and procedures through eviCore® healthcare (eviCore), an independent specialty medical benefits management company, for UT SELECT BCBSTX members effective Sept. 1, 2019.
Here is a list of the categories which will require prior authorization through eviCore:
- Sleep Studies
- Advanced Imaging
- Pain Management
Payment may be denied if you perform procedures without authorization. If this happens, you may not bill your patients. Patient eligibility and benefits should be verified before every scheduled appointment. Be sure to include all appropriate documentation to ensure a thorough review of your request.
It is important to use the Availity® Eligibility and Benefits tool or your preferred vendor to check eligibility and requirements for UT patients and determine whether preauthorization is required based on the procedure code. Obtain fast, efficient, detailed information for BCBSTX UT SELECT members by accessing Availity . Please note that you must be registered with Availity to gain access to this free online tool. Additional tip sheets are available on the BCBSTX provider website under Claims and Eligibility. Availity allows you to determine if preauthorization is required based on the procedure code. Refer to “Eligibility and Benefits” for more information on Availity.
Once you have determined your service requires preauthorization through eviCore, use one of the following methods to obtain authorizations:
- Go online to the eviCore web portal. After a one-time registration, you can initiate a case, check status, review guidelines, view authorizations and eligibility and more. This is the quickest, most efficient way to obtain information.
- Call eviCore at 1-855-252-1117 toll-free between 6 a.m. to 6 p.m. CST, Monday through Friday and 9 a.m. to noon CST, Saturday, Sunday and legal holidays.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Texas (BCBSTX).
iExchange is a trademark of Medecision, Inc. (Medecision), a separate company that provides collaborative health care management solutions for payers and providers. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as eviCore, Availity or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Checking eligibility and benefits and/or obtaining preauthorization/pre-notification for a service is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. Aerial, iExchange and Medecision® are trademarks of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.